Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterine cavity. These misplaced lesions most often affect pelvic organs like the ovaries. However, endometriosis frequently involves the gastrointestinal tract, which is the most common site outside the reproductive organs. When these growths develop on or within the intestines, they cause various digestive problems. This article explores the connection between endometriosis and the bowel, focusing on gastrointestinal symptoms, including mucus in the stool.
How Endometriosis Affects the Gastrointestinal Tract
Bowel or intestinal endometriosis refers to the involvement of the intestines by misplaced uterine-like tissue. These lesions most frequently implant on the rectum and the sigmoid colon, which are the lower parts of the large intestine. The tissue often starts growing on the outermost layer of the bowel, known as the serosa.
A particularly aggressive form is deep infiltrating endometriosis, characterized by lesions that penetrate more than five millimeters beneath the tissue surface. When this deep infiltration occurs in the bowel, the lesions can burrow into the muscularis layer, the thick middle section of the bowel wall. This tissue triggers a chronic inflammatory response, leading to the formation of scar tissue and adhesions.
This inflammation and scarring can significantly alter the normal function and shape of the bowel. The stiffening and thickening of the bowel wall caused by these lesions can narrow the intestinal passageway, a condition known as stenosis. This mechanical obstruction and the constant inflammatory signals disrupt the gut’s normal motility, which is the movement responsible for pushing waste through the digestive tract.
Explaining Bowel Mucus and Other GI Manifestations
Mucus in the stool is a direct consequence of irritation and inflammation caused by endometrial lesions within the bowel wall. The intestinal lining naturally produces mucus to lubricate stool passage and protect the wall. When the bowel is chronically irritated by these lesions, the body produces an excessive amount of mucus as a protective mechanism.
When lesions are large or deeply infiltrated, they are more likely to cause mucus in the stools. This inflammation also leads to other common gastrointestinal symptoms that often worsen during the menstrual cycle, known as catamenial symptoms. One symptom is painful bowel movements, medically termed dyschezia, which occurs when the irritated bowel contracts during defecation.
Other digestive manifestations include cyclical diarrhea or constipation, abdominal bloating, and cramping. These non-specific symptoms can make diagnosis challenging, as they frequently overlap with those of Irritable Bowel Syndrome (IBS). However, the cyclical nature of the pain and the presence of symptoms like mucus in the stool can help distinguish bowel endometriosis from other digestive disorders.
Diagnosis and Management of Bowel Endometriosis
Diagnosing bowel endometriosis requires clinical suspicion and specialized imaging. A doctor specializing in endometriosis will take a detailed patient history, looking for symptoms that intensify during menstruation. Advanced imaging is essential for confirming the presence of lesions and determining their depth and location.
Specialized techniques like transvaginal ultrasound with bowel preparation or Magnetic Resonance Imaging (MRI) targeted for endometriosis visualize the extent of the disease. These tests often identify characteristic nodules or thickening of the bowel wall. While standard colonoscopy is limited in diagnosing endometriosis on the outer layers of the bowel, it may be used to rule out other causes of digestive symptoms.
Management strategies depend on the severity of symptoms and the depth of the lesions. Hormonal suppression therapy is often the first line of treatment, aiming to reduce the activity of the endometriosis tissue and alleviate symptoms. For patients with severe symptoms or significant bowel stenosis, surgical intervention may become necessary.
Surgical options range from conservative methods like shaving the lesion off the bowel surface to more extensive procedures like discoid excision or segmental resection, where a portion of the bowel is removed. Due to the complexity of the surgery, a multidisciplinary team approach involving both a gynecologic surgeon and a colorectal surgeon is generally recommended. The goal of treatment is to excise the disease while preserving organ function and improving the patient’s quality of life.